Endovascular Embolization

Endovascular embolization of AVMs is a rapidly evolving technique. This treatment modality is used primarily as an adjunct to surgery or radio-surgery to reduce blood flow and eliminate surgically inaccessible arterial feeders pre-operatively or to incrementally reduce the size of a large AVM nidus, making it amenable to surgical or radiosurgical treatment. The optimal time between embolization and surgery is not defined. Most surgeons, however, operate within 5-7 days after the last embolization to prevent recruitment of new vessels. In some patients, endovascular embolization may be used as a palliative measure to treat headaches or reverse neurologic deficit, whereas, in a small number of select patients, AVM embolization may be curative (Table 20.4). The long-term

Table 20.4. Results of AVM embolization in the contemporary literature

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